It started in a Hospital: My Writing Life

It started in Hospital: My Writing Life


Francesco Pacifico, a novelist based in Rome, wrote Coronavirus Dispatches for the New York literary magazine, n+1. Number eight in the series was entitled A Breakup Letter to my Writing Career, in which he expressed dissatisfaction with his work.

The truth is you’re not doing it for me anymore.

He came across as mildly funny and somewhat self-absorbed, a feature commonly found in essay writers. He bemoaned the fact that his career made him afraid to do his “real writing”. Pacifico noted how his work had changed over the years.

The thing about a writing career is that it starts by being about writing and then slowly evolves into something else.

Virginia Woolf turned a better phrase on the same note.


Writing is like sex. First you do it for love, then you do it for your friends, and then you do it for money.

By the end of Pacifico’s severance letter it was not clear if he would stop writing.

I’m not even sad about writing this. I’m just excited. Do you see how writing this letter has made my juices start flowing again?

If the end of his writing career is not clear, Pacifico may be better able to pin down when it started. There may have been a period in his life, perhaps during adolescence, when hormones and attendant juices coursed through his vitals, triggering emotions that birthed desires, producing actions and inactions. It could have started anywhere: at school, at home, at work, on a holiday, in a hospital.

My own writing practice started in a hospital. I didn’t know it at the time, but experiencing a lengthy stay in hospital, with the emotions it fired up, launched me as a writer.

I see myself, in pain, worrying, deciding to do something about it. Becoming a patient. Then a writer.

When the pain across your belly suddenly got worse, it was time to get to the hospital, fast. A problem with your appendix crossed your mind, as the abdominal pain, initially low in the belly, migrated further right, like an actor moving downstage in order to upstage other aches and humours. They were few and stable in a fit and active eighteen year old fork-truck driver.

Your mother scoffed gently when you plucked up the courage to tell her that your stools were dense and burnished black as coal. She teased you about drinking stout on late-night sessions over the long weekend.

You rushed to hospital. The pain was continuous and severe. You underwent emergency surgery for a ruptured appendix. You were right all along. You should have sought medical assistance sooner. Your life was in danger. The surgical procedure cut deep and was extensive, lengthy and fraught, not only removing the exploded appendix, but also clearing out the polluted abdominal cavity.

Peritonitis was the threat, an infection of the thin layer of tissues lining the abdomen. Bacteria expelled from the propulsive appendix had taken hold of the tissue and poisoned it. That’s why the pain was so continuous and so severe; it’s why you felt so sick; why your heart-rate soared, though you were standing still, too bent over in pain to move.

The surgery was successful. It took four weeks of follow-up treatment with intravenous pain relief and antibiotics to see off the peritonitis. To see off the danger you had no sense you were about to encounter. You were lucky you got to the hospital in time.

Among the legacies of that incident are a life-long scar, now tucked under your belly-bulge, and the formal beginning of your writing practice. You prefer the term “practice”, with its allusion to habits, skills and the pursuit of excellence. It bears the sheen of service, carried over from the medical professions. You feel the term “practice” is closer to what you actually do, rather than the term “career”, which alludes to distant horizons where work is permanent and secure, where it develops in stages like a rock-climber on a cliff, never happy with the peak bagged on a given day. You rise in value and esteem, until a happy retirement finds you soothed by the comforting riches accrued through your labours.

Both terms are no more than variations on the name of what it is you do. When you answered your mother’s question about getting a job – you were in your early forties by then – you had both terms in mind.

I don’t want a job, Ma. I have plenty of work.

That work started in a hospital, a prime location for writing, full of pain and joy. There were emotional plunges and ascents; relapses and recoveries; dramas, with characters in and out of costume;  stories in a variety of languages, from the specialist argot of the medics to the ward-chat of fellow patients.

You began to fill a notebook with your scribblings: snatches of everything you heard, accounts of scenes and incidents you witnessed, anecdotes told by other patients, descriptions of processes, reactions to events – such as the arrival of a rescue helicopter in a blaze of lights and a whoop-whoop thudding of rotors, right smack onto the capital H whitewashed on the lawn, outside your ward.

Noel Browne, Minister for Health in an Irish coalition government struggling to hold itself together under pressure from contending views, led a drive for the eradication of tuberculosis (T.B.) in the late 1940s. His own family, living in poverty in Waterford, Derry and Dublin, was devastated by T.B., most of them falling ill and dying prematurely. The Minister himself survived relapses of the chronic lung disease throughout his life. This contributed to his drive and reported contrariness. He promoted a national campaign to alleviate poverty and to see off the scourge of T.B..

There are echoes of Browne’s life in mine. I was raised in Waterford and I live in Derry. I was cured of peritonitis in one of the hospitals he caused to be developed. When my lungs failed in later life and I almost breathed my last, the medics who saved me tested for T.B.. It is an ancient disease, enjoying a come-back since economic activity deepened local and global poverty. It causes the largest number of deaths from an infectious disease across the world today. Like modern Coronaviruses, it is spread by close human contact – spitting, coughing, sneezing, speaking. Breathing.

I wrote about the helicopter in my hospital notebook. Did I note the noise, the lights, the hubbub? Did I wonder at the casualty on a gurney, wheeled off at great speed to a ward on the far side of the lawn? Did I admire the rescuers and the hospital staff, dashing about in professional calm? Did I gasp as the helicopter took off? No doubt I wondered if there were more casualties somewhere. A car smash? A shipwreck? I don’t remember if I ever found out. I made something up. I storied the event, populating it with fictional characters from the cast of heroes and victims I saw each day from my hospital bed.

I was in Ardkeen Hospital, Waterford’s general hospital, developed from Browne’s original chest hospital. It is now called Waterford University Hospital, straddling even more of Ard Caoin, a fair and pleasant height above the river Suir. It overlooks King’s Channel and Waterford Castle on The Island, where the river bifurcates before re-joining for its final twists to the ocean. The Suir merges with its sister rivers, the Nore and the Barrow, curves around Passage East, Woodstown, Dunmore East and enters the sea beyond Hook and Crooke. The lay-out of the hospital is white, single storey wards dispersed in the sanatorium-style Browne admired in Switzerland, interspersed with modern multi-storey units. Most of the lawns have been built upon.

I spent five weeks there. I filled two school copybooks with my scribblings. My practice of writing lists began. It continues today. List-writing has been my way out of a writing-doldrum, a feint round an obstacle, a pause between bursts of making. It is a problem-solving technique. It primes my imagination. It fills pages, so it banishes the empty whiteness. I ape the athlete doing stretches and bends, lifts and reaches, jogging on the spot, swinging arms above my head, pivoting my hips, touching my toes, warming up before embracing the marathon of a novel or a play, when I put aside the listing and stride directly into the work to which I intend to commit.

I fell in love with a nurse. I gave her my notebooks. She was my age, learning her trade, already adept and skilful, well-regarded by seniors. We became friendly. I grew emotional. So did she, but perhaps not as much. It’s a common enough tale; the patient, the nurse, romance amidst the dressings and the drips. The healing ministrations.

She wets a washcloth and, holding it above his ankles, squeezes the water onto him, looking up as he murmurs, seeing his smile.

I was no English Patient, as played by Ralph Fiennes. She was not Nana, as played by Juliette Binoche. My notebooks contained none of Ondaatjie’s magic.

Her hand touched my wrist.

If I gave you my life, you would drop it, wouldn’t you?

I didn’t say anything.

A long time later, I regretted giving my notebooks to the nurse. I wish I had them in front of me now, to plumb them for evidence that the writing I went on to do had a source, a bedrock to rest upon. I don’t expect there is any monetary value in them. University libraries will not be bidding against each other to claim my juvenilia.


There was a prologue to the hospital origins of my writing practice, when I was at secondary school. I was a successful academic student and captain of the under 15s Gaelic football team. Teachers gambled my destiny on a professional career in the applied sciences – a doctor, an engineer – if I could be prised away from the warm, working-class nest from which I fledged. I began writing poetry and song lyrics, scribbling in a schoolbook I hid under my desk. Teenage doggerel, I prized it greatly. It marked the adolescent awakening of my will to expression and art. I didn’t show it to anyone. It didn’t fit with my school persona as a smart townie and a jock. Anyway, we already had a class poet,  Plug Molloy.

I arrived breathless and late for an Irish lesson, after a mid-morning break. I needn’t have rushed. The teacher was late too. Most of the class, all male, were already there, standing around, carrying on, settling. There was a scoffing tone in their banter and whooping that I realised was prompted by the fun Plug Molloy was having reading excerpts from my scribblings. Whether he or someone else discovered my notebook, I never found out. A flash of anger forked bright as lightning across my face. I ploughed between the desks, pushing class mates aside. I belted Molloy in the gob. A melée took off, as he and I scuffled boyishly and class mates tried to separate us. The teacher quelled the melée when he arrived. It was petering out anyway.

Opinions divided among my classmates regarding my actions, though most enjoyed the distraction. Some felt that it was bad form to thump a poet, even though he was taller than me. Others thought he deserved it. The fact that Molloy suffered no obvious damage meant that the episode passed off quietly. Molloy didn’t complain. Perhaps I missed him. The teacher played it down. Nobody suffered censure. It was my first experience of the heat created by rivalries among writers. It dampened my urge to write poetry, though I have written verse and songs for plays. I would never be more than a middling pugilist. And rhymer. I wonder what Plug Molloy went on to do after school. I hope he kept writing poetry, possibly penning a minor epic, in an Homeric-style, based on our adolescent strutting and rutting.

The teacher returned my notebook. I have no idea where it ended up. Like the hospital ones, I wish I had it now. It lies with my small pile of lost juvenilia.


That was the prologue. The main event got underway in a hospital. A flux of emotions, among them adolescent love, infused each day with energies that demanded expression. The life-time impulse to create through words emerged. The practice of presenting writing to an audience began in reading excerpts from my notebooks to ward-mates and staff.

My writing practice will probably come to an end in another hospital, when my lungs, my pancreas, my kidneys or my circulatory system plead ‘enough!’. I have no intention of concluding the writing before then. Until the worldly fascination, curiosity and awe I relish each day desert me. Writing is pulmonary. It is an extension of breathing.

There have been other hospitals since the transformed sanatorium on the fair and pleasant height, Ard Caoin. There have been other surgeries: a biopsy of muscle tissue to aid diagnosis of an auto-immune condition; open surgery on an inguinal hernia, in danger of strangulating; transmetatarsal amputations on both feet, to prevent gangrene from setting in. A surfeit of experience and material for a writer.

This place of sutures, incision and surgery is called a theatre. No curtains of heavy velvet but instead disposable blue or green. The stage is a table, a Greek ekkyklema. Every player performs, except the passive patient. Lines to guide the surgeon are drawn on the body, a crude commedia dell’arte.

I quibble with Sinead Gleeson on one point. The patient is not passive. The patient is the heartbeat and the breath of the piece, pumping and bellowing in tandem with machines. Will Pacifico relent and produce Dispatch No. 9? Will he continue, in some other form? I will, until the lungs and the machines cease their truculent wheezing and go silent.


Featured image by Patrick Fore on Unsplash